Lifestyle counselling - a long-term commitment based on partnership.

BACKGROUND: Lifestyle habits are important factors in the development of non-communicable diseases. Different ways of providing counselling in primary care to promote healthier lifestyle habits have been launched and evaluated in recent years. It is important to provide an insight into what makes lifestyle counselling useful for patients and healthcare providers. OBJECTIVE: The overall aim of this study was to explore patients´ and community health nurses´(CHNs) experiences of lifestyle counselling in primary care to support healthier lifestyle habits. METHODS: Patients and CHNs were interviewed, face to face. Sixteen patients (eight men, eight women, aged 51-75 years) diagnosed with hypertension or type 2 diabetes mellitus and three CHNs participated. Data material was analysed with qualitative content analysis to explore the participants experiences of lifestyle counselling. RESULTS: The theme demonstrates that lifestyle counselling is a long-term commitment based on partnership between patients and CHNs. Five categories describe this partnership: respect and mutual interest, understanding of illness, measurements and goal setting, long-term support, and a structure to support counselling within the primary care unit. CONCLUSION: The results from this study are consistent with and add to previous understanding of how lifestyle counselling can be performed successfully in the context of primary health care. The results emphasize that lifestyle counselling should encompass a partnership based on mutual respect, recognition of the patient as the expert on his/her current life situation, and the need for both parties to engage in the process of lifestyle change. PRACTICE IMPLICATIONS: A structured lifestyle program with five counselling sessions within primary care was experienced as helpful for enhanced lifestyle habits and considered to be feasible by both patients and CHNs.

"It's up to me": the experience of patients at high risk of cardiovascular disease of lifestyle change.

OBJECTIVE: Despite knowledge of the effect of lifestyle changes in preventing cardiovascular disease, a large proportion of people have unhealthy lifestyle habits. The aim of our study is a) to explore the experiences of participants at high risk of CVD of lifestyle change after participation in a one-year structured lifestyle counselling programme and b) to link the techniques and strategies used by the participants to the processes of the transtheoretical model of behaviour change (TTM). DESIGN: A qualitative explorative design was used to collect data on participants' experiences. An abductive content analysis was conducted using the processes within TTM for the deductive analysis. SETTING: Patients that participated in a one-year lifestyle counselling programme in Swedish primary care, were interviewed. SUBJECTS: Eight men and eight women, aged 51-75 years, diagnosed with hypertension or type 2 diabetes mellitus. MAIN OUTCOME MEASURES: Experiences of lifestyle change in patients at high cardiovascular risk. RESULTS: The analysis yielded four dimensions that assisted lifestyle change: 'The value of knowledge', 'Taking control', 'Gaining trust in oneself' and 'Living with a chronic condition'. The theme 'It's up to me' illustrated that lifestyle change was a personal matter and responsibility. CONCLUSION: Enhanced knowledge, self-efficacy, support from others and the individual's insight that it was his/her own decisions and actions that mattered were core factors to adopt healthier lifestyle habits. Practice Implications: Although lifestyle change is a personal matter, the support provided by primary healthcare professionals and significant others is essential to increase self-efficacy and motivate lifestyle change. Key Points A large proportion of people persist to have unhealthy lifestyle habits also after receiving a diagnosis of hypertension or diabetes mellitus, type 2. This study contributes to enhanced knowledge of how patients experience lifestyle change after counselling in primary care. Both experiential and behavioural processes as defined by the transtheoretical model of behaviour change were used to make lifestyle changes by the patients in this study.

Reduced 10-year risk of developing cardiovascular disease after participating in a lifestyle programme in primary care.

Background: Despite well-known preventive effects for future cardiovascular disease (CVD) risk through lifestyle changes, scientific evaluations of lifestyle programmes in primary care are scarce. Moreover, structured lifestyle counselling is still not integrated in everyday clinical practice. We aimed to evaluate change in cardiovascular risk factors and Framingham 10-year risk score of developing CVD in men and women at high cardiovascular risk after participation in a structured lifestyle programme over 1 year. A single-group study was carried out with a 1-year follow-up including before and after measurements.Methods: The lifestyle programme comprised five appointments to a district nurse over 1 year, focussing on lifestyle habits based on motivational interviewing. Fasting blood samples and anthropometric measurements were obtained at baseline and 1-year follow-up. The 10-year risk of CVD was calculated according to Framingham general CVD risk score.Results: A total of 404 patients were included in the study. There was a positive change over 1 year in the total study population for all risk factors evaluated. This included improvements in weight, waist circumference, blood pressure, blood lipids, and fasting glucose. The 10-year risk of developing CVD decreased for the total population from 24.8% to 21.4% at 1 year, equivalent to a 14% decrease.Conclusions: A structured lifestyle programme in primary care contributes to significant improvements of cardiovascular risk factors and the reduction of 10-year risk for CVD for both men and women at high cardiovascular risk.

Improved unhealthy lifestyle habits in patients with high cardiovascular risk: results from a structured lifestyle programme in primary care.

Background. Physical activity, healthful dietary habits, and not smoking are associated with reduced cardiovascular morbidity and mortality. However, few studies have examined how counselling to improve poor lifestyle habits might be carried out in clinical practice. In Swedish primary care, structured lifestyle counselling is still not integrated into everyday clinical practice. The aim of the present study was two-fold: (1) to describe a novel lifestyle intervention programme in primary care; and (2) to evaluate change in unhealthy lifestyle habits over 1 year in men and women with high cardiovascular risk who participated in the lifestyle intervention programme. Method. A single-group study with a 1-year follow-up was carried out. A total of 417 people was enrolled, median age 62 years (54% women), with either hypertension (69%), type 2 diabetes mellitus, or impaired glucose tolerance. The 1-year intervention included five counselling sessions that focused on lifestyle habits, delivered by a district nurse with postgraduate credits in diabetes care and the metabolic syndrome. All patients were offered in-depth counselling for one or more lifestyle habits when needed. Lifestyle habits were assessed by a questionnaire at baseline and 1-year follow-up. Total change was assessed using a nine-factor unhealthy lifestyle habit index. Results. Favourable, significant changes were observed for physical activity, dietary habits, smoking, and stress over 1 year. Similar improvements were seen for both sexes and type of diagnosis. Conclusions. The results support the utility of a multifactorial, structured approach to change unhealthy lifestyle habits for cardiovascular risk prevention in a primary care setting.

Decrease of pregnant women's pelvic pain after acupuncture: a randomized controlled single-blind study.

BACKGROUND: The efficacy of acupuncture on low-back and/or pelvic pain in late pregnancy is reviewed in few reports. Our aim was to evaluate the effects of two different acupuncture stimulation modes on pelvic pain intensity and some emotional symptoms due to the pain condition. METHODS: In a prospective randomized controlled single-blind study, pregnant women with pelvic pain, median gestational age 26 weeks (range 18-35), were given 10 acupuncture treatments. Needles were inserted subcutaneously over acupuncture points without further stimulation (superficial, n=22), or intramuscular and stimulated repeatedly until a perceived sensation of numbness, de qi, (deep, n=25). Self-reported pain intensity at rest and during daily activities was assessed on a visual analog scale. The variables pain, emotional reactions, and loss of energy were assessed according to the Nottingham Health Profile questionnaire. Changes in assessed variables were analyzed with a nonparametric statistical method allowing for analysis of systematic group changes separated from additional individual changes. RESULTS: After acupuncture stimulation, significant systematic group changes towards lower levels of pain intensity at rest and in daily activities as well as in rated emotional reaction and loss of energy were seen. The results also showed additional individual changes in most variables. In this study, no differences between the effects induced by the superficial and deep acupuncture stimulation modes were observed. CONCLUSION: Acupuncture stimulation that is individually designed may be a valuable treatment to ameliorate suffering in the condition of pelvic pain in late pregnancy.